Ensuring the effective use of evidence-based practices in real-world clinical settings can be challenging. We believe that nurses play a key role in the implementation of such practices, especially practices aimed at preventing healthcare-associated infection. Catheter-related urinary tract infection} the most frequent healthcare-associated infection in the United States} is a costly and potentially lethal condition. The state of Michigan is initiating an ambitious patient safety project to ameliorate the burden of disease associated with indwelling catheterization. The overarching objective of this research is to identify and develop strategies to optimize the implementation of key practices in the field of patient safety and healthcare-associated infection prevention. This study has three aims: 1) To describe the adoption and implementation of a Catheter-Associated Urinary Tract Infection Prevention Bundle (Bladder Bundle) as part of a Michigan state-wide patient safety initiative and assess patient outcomes such as catheter utilization and infection rates;2) To identify and compare the barriers to and facilitators of implementing the Bladder Bundle across a diverse group of hospitals;and 3) To develop and evaluate strategies to facilitate implementation of the Bladder Bundle and assess patient outcomes including catheter utilization, discontinuation, re-insertion, and infection rates. This investigation includes the collection and analysis of both quantitative and qualitative data. We have assembled an interdisciplinary team that has already worked successfully together on a prior study to conduct this timely and innovative patient safety project. For the first aim we will use survey methods to describe the diffusion, adoption, and implementation of the Bladder Bundle and key patient outcomes. For the second aim we will use primarily qualitative methods, consisting of both phone interviews and site visits. This approach will allow us to examine in greater depth complex organizational factors that serve as either facilitators or barriers to implementing the Bladder Bundle. We will also develop implementation strategies and tools that will then be evaluated in collaboration with three hospitals that are in the process of implementing the Bladder Bundle. For the third aim we propose to collect qualitative data before, during, and after the implementation of the intervention in order to conduct a formative evaluation, including an evaluation of implementation process, attainment, and sustainability. We will also collect quantitative data on patient outcomes such as catheter use, discontinuation, and infection rates. PUBLIC HEALTH RELEVANCE: Catheter-related urinary tract infection is a common, costly, and potentially lethal condition. The purpose of this research is to develop methods to help prevent catheter-related urinary tract infection. Our study will also provide insight on how to prevent other healthcare-associated infections, thereby creating a safer healthcare system.